利用静息态磁共振成像评估脑血管疾病患者的脑血管储备：一项可行性研究。
Evaluation of cerebrovascular reserve in patients with cerebrovascular diseases using resting-state MRI: A feasibility study.
作者信息
Taneja Kamil, Lu Hanzhang, Welch Babu G, Thomas Binu P, Pinho Marco, Lin Doris, Hillis Argye E, Liu Peiying
机构信息
The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA.
出版信息
Magn Reson Imaging. 2019 Jun;59:46-52. doi: 10.1016/j.mri.2019.03.003. Epub 2019 Mar 5.
PURPOSE
To demonstrate the feasibility of mapping cerebrovascular reactivity (CVR) using resting-state functional MRI (fMRI) data without gas or other challenges in patients with cerebrovascular diseases and to show that brain regions affected by the diseases have diminished vascular reactivity.
MATERIALS AND METHODS
Two sub-studies were performed on patients with stroke and Moyamoya disease. In Study 1, 20 stroke patients (56.3 ± 9.7 years, 7 females) were enrolled and resting-state blood‑oxygenation-level-dependent (rs-BOLD) fMRI data were collected, from which CVR maps were computed. CVR values were compared across lesion, perilesional and control ROIs defined on anatomic images. Reproducibility of the CVR measurement was tested in 6 patients with follow-up scans. In Study 2, rs-BOLD fMRI and dynamic susceptibility contrast (DSC) MRI scans were collected in 5 patients with Moyamoya disease (32.4 ± 8.2 years, 4 females). Cerebral blood flow (CBF), cerebral blood volume (CBV), and time-to-peak (TTP) maps were obtained from the DSC MRI data. CVR values were compared between stenotic brain regions and control regions perfused by non-stenotic arteries.
RESULTS
In stroke patients, lesion CVR (0.250 ± 0.055 relative unit (r.u.)) was lower than control CVR (0.731 ± 0.088 r.u., p = 0.0002). CVR was also lower in the perilesional regions in a graded manner (perilesion 1 CVR = 0.422 ± 0.051 r.u., perilesion 2 CVR = 0.492 ± 0.046 r.u.), relative to that in the control regions (p = 0.005 and 0.036, respectively). In the repeatability analysis, a strong correlation was observed between lesion CVR (r = 0.91, p = 0.006) measured at two time points, as well as between control CVR (r = 0.79, p = 0.036) at two time points. In Moyamoya patients, CVR in the perfusion deficit regions delineated by DSC TTP maps (0.178 ± 0.189 r.u.) was lower than that in the control regions (0.868 ± 0.214 r.u., p = 0.013). Furthermore, the extent of reduction in CVR was significantly correlated with the extent of lengthening in TTP (r = 0.91, p = 0.033).
CONCLUSION
Our findings suggested that rs-BOLD data can be used to reproducibly evaluate CVR in patients with cerebrovascular diseases without the use of any vasoactive challenges.
目的
证明在脑血管疾病患者中，使用静息态功能磁共振成像（fMRI）数据绘制脑血管反应性（CVR）图谱的可行性，且无需气体或其他刺激，并表明受疾病影响的脑区血管反应性降低。
材料与方法
对中风和烟雾病患者进行了两项子研究。在研究1中，招募了20名中风患者（56.3±9.7岁，7名女性），收集静息态血氧水平依赖（rs-BOLD）fMRI数据，并据此计算CVR图谱。比较在解剖图像上定义的病变、病变周围和对照感兴趣区（ROI）的CVR值。对6名患者进行随访扫描，测试CVR测量的可重复性。在研究2中，对5名烟雾病患者（32.4±8.2岁，4名女性）进行了rs-BOLD fMRI和动态磁敏感对比（DSC）MRI扫描。从DSC MRI数据中获得脑血流量（CBF）、脑血容量（CBV）和达峰时间（TTP）图谱。比较狭窄脑区和由非狭窄动脉供血的对照区的CVR值。
结果
在中风患者中，病变区CVR（0.250±0.055相对单位（r.u.））低于对照区CVR（0.731±0.088 r.u.，p = 0.0002）。病变周围区域的CVR也呈梯度降低（病变周围1区CVR = 0.422±0.051 r.u.，病变周围2区CVR = 0.492±0.046 r.u.），相对于对照区（分别为p = 0.005和0.036）。在重复性分析中，两个时间点测量的病变区CVR之间（r = 0.91，p = 0.006）以及对照区CVR之间（r = 0.79，p = 0.036）均观察到强相关性。在烟雾病患者中，由DSC TTP图谱勾勒出的灌注缺损区的CVR（0.178±0.189 r.u.）低于对照区（0.868±0.214 r.u.，p = 0.013）。此外，CVR降低的程度与TTP延长的程度显著相关（r = 0.91，p = 0.033）。
结论
我们的研究结果表明，rs-BOLD数据可用于在不使用任何血管活性刺激的情况下，对脑血管疾病患者的CVR进行可重复性评估。
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